EP2564814A1 - Stemless shoulder implant assembly - Google Patents
Stemless shoulder implant assembly Download PDFInfo
- Publication number
- EP2564814A1 EP2564814A1 EP20120250146 EP12250146A EP2564814A1 EP 2564814 A1 EP2564814 A1 EP 2564814A1 EP 20120250146 EP20120250146 EP 20120250146 EP 12250146 A EP12250146 A EP 12250146A EP 2564814 A1 EP2564814 A1 EP 2564814A1
- Authority
- EP
- European Patent Office
- Prior art keywords
- base plate
- assembly
- humerus
- joint head
- joint
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Withdrawn
Links
- 239000007943 implant Substances 0.000 title claims abstract description 52
- 210000002758 humerus Anatomy 0.000 claims abstract description 65
- 241000309551 Arthraxon hispidus Species 0.000 claims abstract description 41
- 241001653121 Glenoides Species 0.000 claims abstract description 30
- 210000000323 shoulder joint Anatomy 0.000 claims abstract description 15
- 230000002093 peripheral effect Effects 0.000 claims abstract description 11
- 210000003710 cerebral cortex Anatomy 0.000 claims abstract description 8
- 229910052588 hydroxylapatite Inorganic materials 0.000 claims description 8
- XYJRXVWERLGGKC-UHFFFAOYSA-D pentacalcium;hydroxide;triphosphate Chemical compound [OH-].[Ca+2].[Ca+2].[Ca+2].[Ca+2].[Ca+2].[O-]P([O-])([O-])=O.[O-]P([O-])([O-])=O.[O-]P([O-])([O-])=O XYJRXVWERLGGKC-UHFFFAOYSA-D 0.000 claims description 8
- 229910000684 Cobalt-chrome Inorganic materials 0.000 claims description 4
- 239000010952 cobalt-chrome Substances 0.000 claims description 4
- 239000000919 ceramic Substances 0.000 claims description 3
- RTAQQCXQSZGOHL-UHFFFAOYSA-N Titanium Chemical compound [Ti] RTAQQCXQSZGOHL-UHFFFAOYSA-N 0.000 claims description 2
- 229910045601 alloy Inorganic materials 0.000 claims description 2
- 239000000956 alloy Substances 0.000 claims description 2
- 229920000642 polymer Polymers 0.000 claims description 2
- 229910001220 stainless steel Inorganic materials 0.000 claims description 2
- 239000010936 titanium Substances 0.000 claims description 2
- 229910052719 titanium Inorganic materials 0.000 claims description 2
- 239000000463 material Substances 0.000 claims 2
- 229910001069 Ti alloy Inorganic materials 0.000 claims 1
- 239000011248 coating agent Substances 0.000 claims 1
- 238000000576 coating method Methods 0.000 claims 1
- 210000000988 bone and bone Anatomy 0.000 description 27
- 210000004095 humeral head Anatomy 0.000 description 14
- 206010003246 arthritis Diseases 0.000 description 3
- 230000000712 assembly Effects 0.000 description 3
- 238000000429 assembly Methods 0.000 description 3
- 238000005524 ceramic coating Methods 0.000 description 3
- 230000001054 cortical effect Effects 0.000 description 3
- 230000012010 growth Effects 0.000 description 3
- 238000003780 insertion Methods 0.000 description 3
- 230000037431 insertion Effects 0.000 description 3
- 238000004873 anchoring Methods 0.000 description 2
- 230000008468 bone growth Effects 0.000 description 2
- 238000000034 method Methods 0.000 description 2
- 206010028391 Musculoskeletal Pain Diseases 0.000 description 1
- 208000007613 Shoulder Pain Diseases 0.000 description 1
- 229910000389 calcium phosphate Inorganic materials 0.000 description 1
- 239000001506 calcium phosphate Substances 0.000 description 1
- 235000011010 calcium phosphates Nutrition 0.000 description 1
- 239000004568 cement Substances 0.000 description 1
- 230000007850 degeneration Effects 0.000 description 1
- 239000012634 fragment Substances 0.000 description 1
- 229910052500 inorganic mineral Inorganic materials 0.000 description 1
- 230000010354 integration Effects 0.000 description 1
- 210000001503 joint Anatomy 0.000 description 1
- 238000004519 manufacturing process Methods 0.000 description 1
- 229910052751 metal Inorganic materials 0.000 description 1
- 239000002184 metal Substances 0.000 description 1
- 239000011707 mineral Substances 0.000 description 1
- 239000010935 stainless steel Substances 0.000 description 1
- 239000000126 substance Substances 0.000 description 1
- QORWJWZARLRLPR-UHFFFAOYSA-H tricalcium bis(phosphate) Chemical compound [Ca+2].[Ca+2].[Ca+2].[O-]P([O-])([O-])=O.[O-]P([O-])([O-])=O QORWJWZARLRLPR-UHFFFAOYSA-H 0.000 description 1
- 230000003313 weakening effect Effects 0.000 description 1
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/40—Joints for shoulders
- A61F2/4003—Replacing only the epiphyseal or metaphyseal parts of the humerus, i.e. endoprosthesis not comprising an entire humeral shaft
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/86—Pins or screws or threaded wires; nuts therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
- A61F2002/30332—Conically- or frustoconically-shaped protrusion and recess
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
- A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
- A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
- A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
- A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
- A61F2002/30884—Fins or wings, e.g. longitudinal wings for preventing rotation within the bone cavity
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/40—Joints for shoulders
- A61F2/4003—Replacing only the epiphyseal or metaphyseal parts of the humerus, i.e. endoprosthesis not comprising an entire humeral shaft
- A61F2002/4007—Replacing only the epiphyseal or metaphyseal parts of the humerus, i.e. endoprosthesis not comprising an entire humeral shaft implanted without ablation of the whole natural humeral head
Definitions
- the present invention relates to a modular implant assembly for replacement of a shoulder joint having a humerus and a glenoid, the implant assembly being attached to the humerus by stemless means.
- the modular implant assembly of the present invention may be articulated with the patient's own glenoid or a prosthetic glenoid.
- the present invention also relates to an assembly of implant components for a glenohumeral shoulder joint.
- the present invention provides an implant assembly for fixation to the humerus without a requirement for either a stem or cement.
- the present invention provides a less invasive implant assembly and therefore does not have the disadvantages of the prior art.
- the present invention relates to a modular means of replacing the ball of the shoulder joint and anchoring it to the joint.
- the implant assembly as described by the present invention may be articulated with the patient's own glenoid or a replacement glenoid.
- a modular implant assembly for a shoulder joint having a humerus and a glenoid, the assembly comprising a base plate, a joint head having a convex outer surface and a generally planar base and which is configured to couple with said base plate, and wherein said base plate is configured with stemless means for fixation to the humerus.
- the base plate further comprises at least three radially displaced screws configured to attach said base plate to the humerus, wherein said screws attach to the peripheral cortical regions of the humerus.
- the shoulder is a ball and socket joint, the ball being the head of the humerus and the socket being the glenoid.
- a normal shoulder joint having a humerus and a glenoid may degenerate over time as a result of arthritis or other age-related conditions. When shoulder joint degeneration advances such that the shoulder no longer functions or movement is extremely painful, the normal shoulder joint may be replaced with a prosthetic shoulder joint.
- Figure 1 shows person 101 suffering from arthritis with a prosthetic shoulder joint 102 implanted in her right shoulder. Shoulder replacement has provided good clinical results over the past 15 years and improved quality of life of patients suffering from shoulder pain.
- FIG. 2 A cross-sectional view of a normal shoulder joint having a humerus 201 and a glenoid 202 in a healthy person is shown in Figure 2 .
- the shoulder is a ball and socket joint, the ball being the head of the humerus and the socket being the glenoid.
- FIG. 3a A traditional anatomical glenohumeral shoulder replacement is shown in Figure 3a , in which the prosthetic humeral component 301 is attached to the humerus 302 by a stem 303.
- the patient's humeral head is resected or cut, creating a cavity in the central intramedullary canal of the patient's humerus.
- the prosthetic humeral component 301 is then attached to the patient's humerus 302 by means of stem 303 inserted into this central canal of their humerus 302.
- the prosthetic humeral component 301 is also known as prosthetic humeral head 301.
- Prosthetic humeral component 301 may articulate with the patient's own glenoid if it has not degenerated or a prosthetic glenoid.
- glenoid component 304 which has a concave element, is attached to the glenoid 305 via glenoid backing plate 306.
- humeral stem 303 When a humeral stem 303 is used, the central region of the humeral bone must be removed to allow the humeral stem 303 to be inserted into the humerus. A cavity is thereby created in the intramedullary canal of the humerus.
- humeral stem 303 to attach prosthetic humeral head 301 to the patient's natural humerus 302.
- a large amount of bone needs to be removed for the insertion of the stem, weakening the bone and therefore the stem can cause the bone to fracture at implant.
- the bone at the centre of the patient's natural humerus is soft and therefore may cause the prosthetic humerus to sink over time.
- Figure 3b shows an individual prosthetic humeral stem 303.
- This stem is shaped to fit within the intramedullary canal of the patient's humerus 302.
- a prosthetic humeral head 301 may be anchored on to the top of this prosthetic humeral stem 303.
- Figures 4a and 4b each show an implant assembly for a shoulder joint embodying the present invention.
- Figure 4a shows the joint head 401 fixed to the humerus 402.
- FIG 4a the patient's humeral head has been resected or cut and a prosthetic humeral head 401 has been attached to the patient's humeral head by means other than a stem.
- a stem has not been inserted into the humerus to allow attachment of the prosthetic humeral head to the patient's humerus, this means that the disadvantages of the prior art as described under Figure 3 are not encountered.
- a large amount of central humeral bone no longer needs to be removed for the insertion of the stem, thereby reducing the possibility of the a fracture of the humerus at implant.
- the joint head 401 is attached to peripheral cortical regions of the patient's humerus instead of the softer central intramedullary canal of the patient's humerus as in the prior art.
- the peripheral cortical regions are much harder than the central intramedullary canal of the bone and therefore there is a reduced chance of the prosthetic implant sinking over time.
- the implant assembly embodied by the present invention is therefore much less invasive than prior art shoulder implant assemblies.
- the replacement humerus 401 shown in Figure 4a may be articulated with the patient's natural glenoid or with a prosthetic glenoid component.
- Figure 4b shows a joint head 401 embodying the present invention fixed to the patient's humerus 402, articulated with a prosthetic glenoid component 403.
- a prosthetic glenoid component 403 and prosthetic glenoid backing plate 404 are used.
- the prosthetic glenoid shown in Figure 4b is a modular system.
- a modular system of components allows for customisation of prosthetic implants whilst enabling a minimum component set to be used by surgeons, without compromising clinical choice.
- FIG. 5 A side view of the implant assembly 501 embodying the present invention is shown in Figure 5 .
- a joint head having a convex outer surface 502 and a generally planar base 503 is shown.
- Base plate 504 as shown in Figure 5 is configured with stemless means for fixation 505 to the humerus.
- Screws 505 are shown as the stemless means for fixation to the humerus in Figure 5 .
- the stemless means for fixation may alternatively be pegs or anchors (not shown).
- Base plate 504 in contrast to the prior art, is attached to a patient's humerus without using a humeral stem. Screws 505 are used to attach the base plate 504 to the patient's resected humeral head. The screws attach to peripheral cortical regions of the resected humeral head, which are stronger and harder than the central regions of the humeral bone. The screws 505 therefore advantageously give an improved connection to the patient's humerus over the prior art, which uses a stem to attach the prosthetic humerus to the central regions of the patient's humerus. The base plate 504 is therefore specially adapted to give good contact around the hard cortical bone of the patient's resected humerus.
- FIGS 6a, 6b and 6c show screws 602 as means of attachment of the implant assembly 601 to a patient's humerus.
- the means of attachment of the implant assembly 601 to the patient's resected humerus may alternatively be anchors or pegs (not shown).
- Screws 602 shown in Figures 6a and 6b are three radially displaced screws 602 and are configured to attach the base plate 603 to the patient's humerus. Screws 602 are locked to base plate 603 with caps, providing a good fixation. In an alternative embodiment (not shown) more than three radially displaced screws may be used. Screws 602 aid the primary stability of the implant assembly 601, giving secure anchorage of the prosthetic in the patient's humerus without use of a long stem.
- the screws 604 anchor the base plate to peripheral cortical regions of bone.
- the humeral bone cortex is stronger and harder than the central regions of the humeral bone, and therefore attachment to the cortex provides better support.
- the present invention thereby brings prosthesis stability to the periphery of the patient's humeral bone.
- a perspective view of the joint head 701 of the implant assembly having a convex outer surface 702 and a generally planar base 703 is shown in Figure 7 .
- the convex outer surface 702 may be hemi-spherical or hemi-ellipsoidal.
- the hemi-spherical or hemi-ellipsoidal nature of the joint head mimics the patient's natural humeral head.
- the implant assembly 701 may also be fabricated in different sizes so as to provide a range of sizes from which the surgeon can select the most appropriate size for the patient.
- hemi-spherical stemless joint heads may be fabricated having a diameter of 42mm, 46mm, 50mm or 54mm.
- the modular nature of the implant assembly embodied by the present invention therefore means that a single base plate can be used in conjunction with a number of joint heads having different sizes and shapes. This advantageously allows for a minimum number of components in the operating theatre without compromising clinical choice for the patient.
- FIG 8 shows a cross sectional view of an implant assembly embodying the present invention.
- the modular nature of the implant assembly is apparent and as shown in Figure 8 , the implant assembly 801 has two components.
- the implant assembly 801 comprises a joint head 802 and a base plate 803.
- the joint head 802 has a convex outer surface which may be shaped so as to give rise to a hemi-spherical or hemi-ellipsoidal outer surface.
- the joint head 802 also has a generally planar base.
- the generally planar base of the joint head 802 has a lip 804 at each side.
- the base plate 803 has angled sidewalls.
- Base plate 803 is attached to the patient's resected humeral head via stemless means.
- Base plate 803 is anchored to peripheral cortical regions of humeral bone.
- the humeral bone cortex is stronger and harder than the central regions of the humeral bone, and therefore attachment to the cortex provides better support than attachment to central regions as in the prior art.
- the present invention thereby brings prosthesis stability to the periphery of the patient's humeral bone.
- the joint head 802 is coupled with the base plate.
- Each lip 804 of the generally planar base of the joint head 802 is aligned to receive the angled sidewalls of the base plate 803.
- the base plate 803 couples with the joint head 802 via a peripheral Morse taper 805.
- the joint head 802 is thus locked on to the base plate 803 by a press fit mechanism.
- the diameter of the joint head 802 is greater than that of the base plate 803, and this provides an increased level of stability and security to the implant assembly.
- the Morse taper is internal to the joint head 802 such that the joint head 802 extends over the edge of the base plate 803 when the joint head 802 and base plate 803 are coupled together. This maximises the convex outer surface of the joint head, which advantageously increases the range of movement of the implant assembly once attached in a person's shoulder.
- base plate 803 When base plate 803 is first attached to the patient's humerus, it must not move more than 150 micrometers. However, the means of fixation, as depicted by screws in Figure 8 , provide a high level of primary stability and ensure that there is no movement of more than 150 micrometers.
- the modular nature of the implant assembly 801 means that there are no screws or other means of attachment directly in the joint head 802. This advantageously means that there is no potential damage during manufacture to the glenoid-articulating surface of the joint head.
- the modular nature of the implant assembly 801 also enables joint heads 802 having slightly different sizes and shapes to be used in conjunction with one base plate 803. Therefore, different joint heads 802 can be selected to suit different patients whilst using the same base plate. This advantageously allows for a minimum inventory of components without compromising clinical choice.
- the joint head 802 embodying the present invention can be used in association with a patient's natural glenoid or may alternatively articulate with a prosthetic glenoid.
- the prosthetic glenoid may also be of a modular nature.
- Base plate 902 comprises a protruding elongated portion 903 having a proximal end 904 and distal 905 end.
- the outer surface of the elongated portion is knurled to facilitate integration of the base plate 902 in the patient's resected humerus.
- the outer surface of the elongated portion may be merely roughened or include spikes or grooves. The protruding elongated portion 903 is impacted into the humeral bone.
- Base plate 902 comprises titanium and is coated with hydroxy-apatite ceramic (H.A.C.).
- H.A.C. hydroxy-apatite ceramic
- Supravit® Zoned H.A.C. may be used.
- Hydroxy-apatite is a calcium phosphate complex that is the primary mineral component of bone and teeth.
- Hydroxy-apatite ceramic is a synthetic substance that is similar to naturally occurring hydroxy-apatite found in bone and teeth.
- the Supravit® Zoned hydroxy-apatite ceramic coating deployed in the present invention has been clinically proven to provide high shear strength, thereby increasing the longevity of the prosthetic implant assembly.
- the Supravit® Zoned hydroxy-apatite ceramic coating imparts a high degree of secondary stability to the shoulder prosthetic by encouraging the development of bone growth in the resected area on the patient's humerus. It is known that the growth of bone is inhibited if any movement is present at the interface. Even very small microscopic movement will break new growth. Therefore, if growth is to be encouraged, the implant needs to be held firmly in the required position. In association with the primary stability provided by the screws or alternative means of fixation, the secondary stability provided by the hydroxy-apatite ceramic coating firmly secures the base plate embodied in the present invention in the patient's resected humerus through the encouragement of bone growth into the implant.
- Dome component may alternatively comprise a cobalt chrome alloy or a polymer or stainless steel.
- the base plate may also comprise one or more holes (not shown), which allow for surgical repair of a fractured humerus by feeding wire through the holes to pull fragments of the fracture back around the implant.
- the diameter of the holes is such that they allow surgical wire to pass through, but no greater.
- FIGS. 10a and 10b Perspective views of the implant assembly 1001 embodying the present invention are shown in Figures 10a and 10b .
- Three fins 1002 are positioned between the distal end 1004 of the elongated portion and the base plate 1003. These fins 1002 encourage attachment of the base plate 1003 embodied by the present invention to the resected patient's humerus.
- These fins 1002 are self-cutting and can cut through the humeral cortical bone to aid the secure attachment of the base plate 1003 to the patient's cortical humeral bone.
- Dovetail joints are used to fix the fins 1002 to the base plate 1003, providing a secure anchorage and thereby minimising the possibility of the head being pulled out of the patient's humerus.
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- Health & Medical Sciences (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Cardiology (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Transplantation (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Vascular Medicine (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Prostheses (AREA)
Abstract
A modular implant assembly is provided for a shoulder joint having a humerus and a glenoid. The assembly comprises a base plate and a joint head having a convex outer surface and a generally planar base. The joint head is configured to couple with said base plate. The base plate is configured with means for fixation to the humerus and further comprises at least three radially displaced screws configured to attach said base plate to the humerus, wherein said screws attach to the peripheral cortical region of the humerus.
Description
- This application claims priority from United Kingdom patent application No
11 15 054.7, filed 31 August 2011 - The present invention relates to a modular implant assembly for replacement of a shoulder joint having a humerus and a glenoid, the implant assembly being attached to the humerus by stemless means. The modular implant assembly of the present invention may be articulated with the patient's own glenoid or a prosthetic glenoid. The present invention also relates to an assembly of implant components for a glenohumeral shoulder joint.
- Traditional methods of implanting anatomical prosthetic shoulder assemblies involve anchoring a metal dome-shaped cap to the patient's humerus by a stem that is inserted into the central canal of their humerus. There are many disadvantages to these traditional methods. In particular, a large amount of bone removed needs to be removed from the central region of the humerus for the insertion of the stem. This weakens the humeral bone and the stem can then cause the bone to fracture at implant. Furthermore, the bone at the central region of the humerus is soft and therefore not ideal for preventing the implant from sinking.
- Alternative anatomical prosthetic shoulder assemblies that do not require a stem are known, and in these, the existing ball of the joint is capped. A cap is placed over the end of the patient's humeral head and held in place with a central peg. However, a drawback here is that the ball of the joint is not taken away and this can make subsequent access to the joint socket difficult when it is necessary to intervene, creating problems in terms of replacing the socket in a reliable and reproducible way.
- Unlike the prior art, the present invention provides an implant assembly for fixation to the humerus without a requirement for either a stem or cement. The present invention provides a less invasive implant assembly and therefore does not have the disadvantages of the prior art. The present invention relates to a modular means of replacing the ball of the shoulder joint and anchoring it to the joint. The implant assembly as described by the present invention may be articulated with the patient's own glenoid or a replacement glenoid.
- According to an aspect of the present invention, there is provided a modular implant assembly for a shoulder joint having a humerus and a glenoid, the assembly comprising a base plate, a joint head having a convex outer surface and a generally planar base and which is configured to couple with said base plate, and wherein said base plate is configured with stemless means for fixation to the humerus. The base plate further comprises at least three radially displaced screws configured to attach said base plate to the humerus, wherein said screws attach to the peripheral cortical regions of the humerus.
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Figure 1 shows a person suffering from arthritis having had a stemmed humeral implant fitted in her right shoulder. -
Figure 2 shows a cross sectional view of a shoulder joint having a humerus and a glenoid in a healthy person. -
Figures 3a and 3b show the prior art. A traditional anatomical glenohumeral shoulder replacement is shown inFigure 3a , in which the humeral component is attached to the humerus by a stem.Figure 3b shows an individual humeral stem. -
Figures 4a and 4b each show an implant assembly for a shoulder joint embodying the present invention.Figure 4a shows the joint head fixed to the humerus.Figure 4b shows the joint head fixed to the humerus, in association with a modular glenoid component system. -
Figure 5 shows a side view of the implant assembly embodying the present invention; -
Figure 6a shows a side view of the implant assembly embodying the present invention. -
Figure 6b shows a top view of one side of the implant assembly embodying the present invention. -
Figure 6c shows screws as means of attachment of the implant assembly to the humerus. -
Figure 7 shows a perspective view of the joint head bounded by a convex outer surface and a generally planar base; -
Figure 8 shows a cross sectional view of an implant assembly embodying the present invention; -
Figure 9 shows a cross sectional view of an implant assembly embodying the present invention; -
Figure 10a shows a perspective view of the implant assembly embodying the present invention; -
Figure 10b shows a different perspective view of the implant assembly embodying the present invention. - The shoulder is a ball and socket joint, the ball being the head of the humerus and the socket being the glenoid. A normal shoulder joint having a humerus and a glenoid may degenerate over time as a result of arthritis or other age-related conditions. When shoulder joint degeneration advances such that the shoulder no longer functions or movement is extremely painful, the normal shoulder joint may be replaced with a prosthetic shoulder joint.
Figure 1 showsperson 101 suffering from arthritis with aprosthetic shoulder joint 102 implanted in her right shoulder. Shoulder replacement has provided good clinical results over the past 15 years and improved quality of life of patients suffering from shoulder pain. - A cross-sectional view of a normal shoulder joint having a
humerus 201 and aglenoid 202 in a healthy person is shown inFigure 2 . The shoulder is a ball and socket joint, the ball being the head of the humerus and the socket being the glenoid. - The prior art is shown in
Figures 3a and 3b . - A traditional anatomical glenohumeral shoulder replacement is shown in
Figure 3a , in which the prosthetichumeral component 301 is attached to thehumerus 302 by astem 303. During this shoulder replacement the patient's humeral head is resected or cut, creating a cavity in the central intramedullary canal of the patient's humerus. The prosthetichumeral component 301 is then attached to the patient'shumerus 302 by means ofstem 303 inserted into this central canal of theirhumerus 302. The prosthetichumeral component 301 is also known as prosthetichumeral head 301. - Prosthetic
humeral component 301 may articulate with the patient's own glenoid if it has not degenerated or a prosthetic glenoid. When articulating with a prosthetic glenoid,glenoid component 304 which has a concave element, is attached to theglenoid 305 viaglenoid backing plate 306. - When a
humeral stem 303 is used, the central region of the humeral bone must be removed to allow thehumeral stem 303 to be inserted into the humerus. A cavity is thereby created in the intramedullary canal of the humerus. There are several disadvantages when usinghumeral stem 303 to attach prosthetichumeral head 301 to the patient'snatural humerus 302. A large amount of bone needs to be removed for the insertion of the stem, weakening the bone and therefore the stem can cause the bone to fracture at implant. The bone at the centre of the patient's natural humerus is soft and therefore may cause the prosthetic humerus to sink over time. - Shoulder replacement designs of the prior art fail for a number of reasons including fracture at implant, instability, dislocation and loose humeral attachment.
-
Figure 3b shows an individual prosthetichumeral stem 303. This stem is shaped to fit within the intramedullary canal of the patient'shumerus 302. A prosthetichumeral head 301 may be anchored on to the top of this prosthetichumeral stem 303. -
Figures 4a and 4b each show an implant assembly for a shoulder joint embodying the present invention.Figure 4a shows thejoint head 401 fixed to thehumerus 402. - In
Figure 4a , the patient's humeral head has been resected or cut and a prosthetichumeral head 401 has been attached to the patient's humeral head by means other than a stem. As a stem has not been inserted into the humerus to allow attachment of the prosthetic humeral head to the patient's humerus, this means that the disadvantages of the prior art as described underFigure 3 are not encountered. In particular, a large amount of central humeral bone no longer needs to be removed for the insertion of the stem, thereby reducing the possibility of the a fracture of the humerus at implant. Furthermore, thejoint head 401 is attached to peripheral cortical regions of the patient's humerus instead of the softer central intramedullary canal of the patient's humerus as in the prior art. The peripheral cortical regions are much harder than the central intramedullary canal of the bone and therefore there is a reduced chance of the prosthetic implant sinking over time. The implant assembly embodied by the present invention is therefore much less invasive than prior art shoulder implant assemblies. - The
replacement humerus 401 shown inFigure 4a may be articulated with the patient's natural glenoid or with a prosthetic glenoid component. -
Figure 4b shows ajoint head 401 embodying the present invention fixed to the patient'shumerus 402, articulated with a prostheticglenoid component 403. InFigure 4b , a prostheticglenoid component 403 and prostheticglenoid backing plate 404 are used. The prosthetic glenoid shown inFigure 4b is a modular system. A modular system of components allows for customisation of prosthetic implants whilst enabling a minimum component set to be used by surgeons, without compromising clinical choice. - A side view of the
implant assembly 501 embodying the present invention is shown inFigure 5 . A joint head having a convexouter surface 502 and a generallyplanar base 503 is shown.Base plate 504 as shown inFigure 5 is configured with stemless means forfixation 505 to the humerus.Screws 505 are shown as the stemless means for fixation to the humerus inFigure 5 . The stemless means for fixation may alternatively be pegs or anchors (not shown). -
Base plate 504, in contrast to the prior art, is attached to a patient's humerus without using a humeral stem.Screws 505 are used to attach thebase plate 504 to the patient's resected humeral head. The screws attach to peripheral cortical regions of the resected humeral head, which are stronger and harder than the central regions of the humeral bone. Thescrews 505 therefore advantageously give an improved connection to the patient's humerus over the prior art, which uses a stem to attach the prosthetic humerus to the central regions of the patient's humerus. Thebase plate 504 is therefore specially adapted to give good contact around the hard cortical bone of the patient's resected humerus. -
Figures 6a, 6b and 6c showscrews 602 as means of attachment of theimplant assembly 601 to a patient's humerus. The means of attachment of theimplant assembly 601 to the patient's resected humerus may alternatively be anchors or pegs (not shown).Screws 602 shown inFigures 6a and 6b are three radially displacedscrews 602 and are configured to attach thebase plate 603 to the patient's humerus.Screws 602 are locked tobase plate 603 with caps, providing a good fixation. In an alternative embodiment (not shown) more than three radially displaced screws may be used.Screws 602 aid the primary stability of theimplant assembly 601, giving secure anchorage of the prosthetic in the patient's humerus without use of a long stem. - In contrast to the prior art in which a humeral stem is used to anchor a prosthetic humeral head to the central region of the patient's humerus, the screws 604 anchor the base plate to peripheral cortical regions of bone. The humeral bone cortex is stronger and harder than the central regions of the humeral bone, and therefore attachment to the cortex provides better support. The present invention thereby brings prosthesis stability to the periphery of the patient's humeral bone.
- A perspective view of the
joint head 701 of the implant assembly having a convexouter surface 702 and a generallyplanar base 703 is shown inFigure 7 . The convexouter surface 702 may be hemi-spherical or hemi-ellipsoidal. The hemi-spherical or hemi-ellipsoidal nature of the joint head mimics the patient's natural humeral head. Theimplant assembly 701 may also be fabricated in different sizes so as to provide a range of sizes from which the surgeon can select the most appropriate size for the patient. For example, hemi-spherical stemless joint heads may be fabricated having a diameter of 42mm, 46mm, 50mm or 54mm. - The modular nature of the implant assembly embodied by the present invention therefore means that a single base plate can be used in conjunction with a number of joint heads having different sizes and shapes. This advantageously allows for a minimum number of components in the operating theatre without compromising clinical choice for the patient.
-
Figure 8 shows a cross sectional view of an implant assembly embodying the present invention. The modular nature of the implant assembly is apparent and as shown inFigure 8 , theimplant assembly 801 has two components. Theimplant assembly 801 comprises ajoint head 802 and abase plate 803. - The
joint head 802 has a convex outer surface which may be shaped so as to give rise to a hemi-spherical or hemi-ellipsoidal outer surface. Thejoint head 802 also has a generally planar base. The generally planar base of thejoint head 802 has alip 804 at each side. Thebase plate 803 has angled sidewalls. -
Base plate 803 is attached to the patient's resected humeral head via stemless means.Base plate 803 is anchored to peripheral cortical regions of humeral bone. The humeral bone cortex is stronger and harder than the central regions of the humeral bone, and therefore attachment to the cortex provides better support than attachment to central regions as in the prior art. The present invention thereby brings prosthesis stability to the periphery of the patient's humeral bone. - Once
base plate 803 is firmly anchored into the humeral cortex, thejoint head 802 is coupled with the base plate. Eachlip 804 of the generally planar base of thejoint head 802 is aligned to receive the angled sidewalls of thebase plate 803. Thebase plate 803 couples with thejoint head 802 via aperipheral Morse taper 805. Thejoint head 802 is thus locked on to thebase plate 803 by a press fit mechanism. - The diameter of the
joint head 802 is greater than that of thebase plate 803, and this provides an increased level of stability and security to the implant assembly. The Morse taper is internal to thejoint head 802 such that thejoint head 802 extends over the edge of thebase plate 803 when thejoint head 802 andbase plate 803 are coupled together. This maximises the convex outer surface of the joint head, which advantageously increases the range of movement of the implant assembly once attached in a person's shoulder. - When
base plate 803 is first attached to the patient's humerus, it must not move more than 150 micrometers. However, the means of fixation, as depicted by screws inFigure 8 , provide a high level of primary stability and ensure that there is no movement of more than 150 micrometers. - The modular nature of the
implant assembly 801 means that there are no screws or other means of attachment directly in thejoint head 802. This advantageously means that there is no potential damage during manufacture to the glenoid-articulating surface of the joint head. - The modular nature of the
implant assembly 801 also enablesjoint heads 802 having slightly different sizes and shapes to be used in conjunction with onebase plate 803. Therefore, differentjoint heads 802 can be selected to suit different patients whilst using the same base plate. This advantageously allows for a minimum inventory of components without compromising clinical choice. Thejoint head 802 embodying the present invention can be used in association with a patient's natural glenoid or may alternatively articulate with a prosthetic glenoid. The prosthetic glenoid may also be of a modular nature. - A cross sectional view of an
implant assembly 901 embodying the present invention is shown inFigure 9 .Base plate 902 comprises a protrudingelongated portion 903 having aproximal end 904 and distal 905 end. As shown inFigure 9 , the outer surface of the elongated portion is knurled to facilitate integration of thebase plate 902 in the patient's resected humerus. In an alternative embodiment (not shown) the outer surface of the elongated portion may be merely roughened or include spikes or grooves. The protrudingelongated portion 903 is impacted into the humeral bone. -
Base plate 902 comprises titanium and is coated with hydroxy-apatite ceramic (H.A.C.). Supravit® Zoned H.A.C. may be used. Hydroxy-apatite is a calcium phosphate complex that is the primary mineral component of bone and teeth. Hydroxy-apatite ceramic is a synthetic substance that is similar to naturally occurring hydroxy-apatite found in bone and teeth. The Supravit® Zoned hydroxy-apatite ceramic coating deployed in the present invention has been clinically proven to provide high shear strength, thereby increasing the longevity of the prosthetic implant assembly. The Supravit® Zoned hydroxy-apatite ceramic coating imparts a high degree of secondary stability to the shoulder prosthetic by encouraging the development of bone growth in the resected area on the patient's humerus. It is known that the growth of bone is inhibited if any movement is present at the interface. Even very small microscopic movement will break new growth. Therefore, if growth is to be encouraged, the implant needs to be held firmly in the required position. In association with the primary stability provided by the screws or alternative means of fixation, the secondary stability provided by the hydroxy-apatite ceramic coating firmly secures the base plate embodied in the present invention in the patient's resected humerus through the encouragement of bone growth into the implant. - Joint head comprises highly polished cobalt chrome. Dome component may alternatively comprise a cobalt chrome alloy or a polymer or stainless steel.
- The base plate may also comprise one or more holes (not shown), which allow for surgical repair of a fractured humerus by feeding wire through the holes to pull fragments of the fracture back around the implant. The diameter of the holes is such that they allow surgical wire to pass through, but no greater.
- Perspective views of the
implant assembly 1001 embodying the present invention are shown inFigures 10a and 10b . Threefins 1002 are positioned between thedistal end 1004 of the elongated portion and thebase plate 1003. Thesefins 1002 encourage attachment of thebase plate 1003 embodied by the present invention to the resected patient's humerus. Thesefins 1002 are self-cutting and can cut through the humeral cortical bone to aid the secure attachment of thebase plate 1003 to the patient's cortical humeral bone. Dovetail joints are used to fix thefins 1002 to thebase plate 1003, providing a secure anchorage and thereby minimising the possibility of the head being pulled out of the patient's humerus.
Claims (14)
- A modular implant assembly for a shoulder joint having a humerus and a glenoid, the assembly comprising;
a base plate,
a joint head having a convex outer surface and a generally planar base and which is configured to couple with said base plate,
wherein said base plate is configured with stemless means for fixation to the humerus, and further comprising at least three radially displaced screws configured to attach said base plate to the humerus, and wherein said screws attach to peripheral cortical regions of the humerus. - The assembly of claim 1, wherein said stemless means for fixation is a screw or a peg or an anchor.
- The assembly of claim 1, wherein the convex outer surface of the joint head is hemi-spherical or hemi-ellipsoidal.
- The assembly of claim 1, wherein said joint head couples with said base plate via a peripheral Morse taper.
- The assembly of claim 4, wherein said peripheral Morse taper is internal to said joint head such that said joint head extends over the edge of said base plate.
- The assembly of claim 1, wherein the generally planar base of said joint head has a diameter greater than the diameter of said base plate.
- The assembly of claim 1, wherein said base plate further comprises a protruding elongated portion having a proximal end and a distal end.
- The assembly of claim 7, wherein said elongated portion has a knurled outer surface.
- The assembly of claim 7, wherein said elongated portion further comprises at least one fin positioned between the distal end of the elongated portion and said base plate.
- The assembly of claim 9, comprising three radially displaced fins positioned between the distal end of the elongated portion and said base plate.
- The assembly of claim 1, wherein the base plate comprises a material selected from the group consisting of titanium, titanium alloys and polymers.
- The assembly of claim 1, wherein the joint head comprises a material selected from cobalt chrome, cobalt chrome alloys and stainless steels.
- The assembly of claim 1, wherein an outer surface of said base plate comprises a coating of hydroxy-apatite ceramic.
- The assembly of claim 1, further comprising a modular glenoid component, comprising a concave bearing member, wherein said joint head articulates with said concave bearing member.
Applications Claiming Priority (1)
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GB1115054.7A GB2494388A (en) | 2011-08-31 | 2011-08-31 | Stemless shoulder implant assembly |
Publications (1)
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EP2564814A1 true EP2564814A1 (en) | 2013-03-06 |
Family
ID=44882014
Family Applications (1)
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EP20120250146 Withdrawn EP2564814A1 (en) | 2011-08-31 | 2012-08-31 | Stemless shoulder implant assembly |
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GB (1) | GB2494388A (en) |
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CN105120804A (en) * | 2013-03-15 | 2015-12-02 | 催化剂整形外科有限公司 | Humeral arthroplasty |
USD745678S1 (en) | 2010-07-06 | 2015-12-15 | Tornier, Inc. | Prosthesis anchor |
US20160324648A1 (en) * | 2014-01-24 | 2016-11-10 | Tornier, Inc. | Humeral implant anchor system |
WO2017165090A3 (en) * | 2016-03-25 | 2017-11-02 | Tornier, Inc. | Stemless shouder implant with fixation components |
WO2018039493A1 (en) | 2016-08-24 | 2018-03-01 | Greiwe Raymond Michael | Humeral head implant system |
US10213243B2 (en) | 2011-07-19 | 2019-02-26 | Tornier, Inc. | Osteotome extractor |
US10722373B2 (en) | 2018-07-27 | 2020-07-28 | Ignite Orthopedics Llc | Implants, systems and methods of using the same |
US10898336B2 (en) | 2006-03-21 | 2021-01-26 | Tornier, Inc. | Femoral and humeral stem geometry and implantation method for orthopedic joint reconstruction |
US11129724B2 (en) | 2016-07-28 | 2021-09-28 | Howmedica Osteonics Corp. | Stemless prosthesis anchor component |
USD951449S1 (en) | 2019-10-01 | 2022-05-10 | Howmedica Osteonics Corp. | Humeral implant |
US11364127B2 (en) | 2018-10-02 | 2022-06-21 | Howmedica Osteonics Corp. | Shoulder prosthesis components and assemblies |
US11399948B2 (en) | 2017-12-11 | 2022-08-02 | Howmedica Osteonics Corp. | Stemless prosthesis anchor components and kits |
US11547572B2 (en) | 2007-01-30 | 2023-01-10 | Tornier Sas | Intra-articular joint replacement |
US11642223B2 (en) | 2019-10-01 | 2023-05-09 | Howmedica Osteonics Corp. | Shoulder prosthesis components and assemblies |
US20230149177A1 (en) * | 2014-01-24 | 2023-05-18 | Howmedica Osteonics Corp. | Humeral implant anchor system |
WO2024015899A3 (en) * | 2022-07-14 | 2024-05-02 | Howmedica Osteonics Corp. | Monolithic baseplate |
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Also Published As
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GB201115054D0 (en) | 2011-10-19 |
GB2494388A (en) | 2013-03-13 |
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